Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

STUDY QUESTION: Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER: Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY: Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION: The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE: Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION: Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS: Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S): The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER: N/A.

Daily Relationship Functioning and Disordered Eating Behaviors Among Sexual Minority Women in Same-Sex Relationships.

BACKGROUND AND PURPOSE: The present study aimed to examine associations between different types of relationship functioning and disordered eating behaviors (DEBs) in the everyday lives of sexual minority women in same-sex relationships-an at-risk population that has not been assessed in this context. METHODS: Participants included 321 young sexual minority women (Mage = 27.56, SD = 3.67) in same-sex relationships who completed surveys assessing their daily relationship functioning and DEB use each day for a 14-day daily diary period. Multilevel structural equation modeling was used to examine daily-, person-, and couple-level associations among women's daily relationship functioning (general relationship functioning, positive and negative relational behaviors they and, separately, their partners engaged in) and DEBs (overeating, loss of control eating, emotional eating, and dietary restriction). RESULTS: Results generally indicated that more positive and less negative daily relationship functioning across all assessed constructs was associated with less same-day emotional eating. In contrast, associations between all daily relationship functioning constructs and loss of control eating were not significant, nor were any relationship functioning-DEB associations at the couple level. More circumscribed patterns of association were identified for associations between the relationship functioning constructs, and overeating and dietary restriction. CONCLUSIONS: Collectively, these findings provide insight into how aspects of daily relationship functioning map onto sexual minority women's daily engagement in DEBs that are linked to poor health long-term, and directions for future research and clinical practice that may warrant consideration moving forward to help advance the evidence-base and care for this historically overlooked and underserved population.

The present study examined associations between different types of relationship functioning (e.g., general relationship functioning, positive and negative relational behaviors that participants and their partners engaged in during their interactions with one another) and disordered eating behaviors (DEBs) in the everyday lives of sexual minority women in same-sex relationships. Results generally indicated that on days when women reported more positive and less negative daily relationship functioning, they also reported less emotional eating that day. In contrast, associations between different types of daily relationship functioning and loss of control eating were not significant. Furthermore, associations between different types of daily relationship functioning relative to overeating and dietary restriction varied based on the type of relationship functioning and DEB under consideration. Collectively, these findings provide insight into how different types of daily relationship functioning map onto sexual minority women's daily engagement in DEBs that are linked to poor health long-term. These findings also provide directions for future research and clinical practice that may warrant consideration moving forward to help advance the evidence base and care for this historically overlooked and underserved population.

Smoking cessation among sexual minority women: Differences in cigarette quit ratios across age, race/ethnicity, and sexual orientation.

OBJECTIVE: Sexual minority (SM) women experience tobacco-related disparities and report a higher prevalence of cigarette use, as well as subgroup differences in use, but little is known about their quitting behavior. This study used data from a national sample of United States SM women to examine cigarette quit ratios overall and by age, race/ethnicity, and sexual orientation. METHODS: Using baseline survey data from the Generations Study (2016-2017, N = 812), we calculated quit ratios among SM women reporting lifetime smoking (100+ cigarettes) who reported currently smoking "not at all" relative to those reporting smoking "every day or some days." Quitting was compared across cohort, race/ethnicity, and sexual orientation, controlling for household income. RESULTS: SM women reporting lifetime smoking in the older cohort were significantly more likely to report quitting than those in the younger cohort. Bisexual women also reported a greater likelihood of quitting than gay/lesbian women. There was no association between race/ethnicity and the probability of quitting smoking. CONCLUSIONS: SM women remain a priority for tobacco prevention and cessation efforts. There is evidence that the probability of quitting cigarettes differs across sexual orientation and age cohorts, which has implications for tailoring of interventions and tobacco communications.

Parenting Desire Among Sexual Minority Women in China: From the Stigma Perspective.

In China, women who are childless or have children outside of heterosexual marriage are generally stigmatized. Consequently, Chinese sexual minority women are challenged for their willingness to have children. This study explored how multiple (structural-interpersonal-individual) levels of sexual minority stigma are related to parenting desire among Chinese sexual minority women. Furthermore, it examined the mediation mechanism of individual stigma and the moderation effect of outness to one's family in the link between structural/interpersonal stigma and parenting desire. Participants (265 lesbian and 193 bisexual women) completed online measures of structural stigma (adherence to Confucianism), interpersonal stigma (discrimination events), individual stigma (internalized homophobia and rejection sensitivity), outness to one's family, and parenting desire. Lesbian women reported lower structural and individual stigma and parenting desire levels than bisexual women. Sexual minority women's high adherence to Confucianism, internalized homophobia, and rejection sensitivity were positively associated with their increased parenting desires. Notably, adherence to Confucianism and discrimination events were associated with parenting desire through internalized homophobia, but not rejection sensitivity; moreover, outness to one's family buffered the direct link between adherence to Confucianism and parenting desire and strengthened the direct link between discrimination events and internalized homophobia and the indirect link between discrimination events and parenting desire. This study contributes to a robust understanding of how sexual minority stigma is connected to parenting desire among sexual minority women in Chinese sociocultural contexts, providing cultural-specific evidence to support theories of stigma and minority stress.

Community connection is associated with lower psychological distress for sexual minority women who view community connection positively.

We examined factors associated with sexual minority women's evaluations of belonging to the lesbian, gay, bisexual, transgender and queer (LGBTQ) community in Australia, and assessed whether a positive view of community participation impacted levels of psychological distress. 2424 cisgender sexual minority women participated in a national, online, cross-sectional survey of LGBTIQ adult Australians' health and well-being. Multivariable regression analyses were conducted to investigate sociodemographic factors associated with sexual minority women's belonging to the LGBTQ community, feelings towards community connection, and associations between community connection and recent psychological distress. Most sexual minority women (58.9%) reported feeling that they are part of the LGBTQ community, and a majority of the participants felt positive about being connected to this community (68.5%). Participants who were bisexual, non-university educated, and who resided in an outer-suburban location were least likely to evaluate participation in the LGBTQ community positively. Feeling positive about community connection was associated with lower levels of psychological distress. Feeling a part of LGBTQ community was associated with lower psychological distress, but this link appears contingent upon positive feelings about community participation. Sexual minority women's' relationships to the LGBTQ community are often complex, and community connection and participation in and of itself is not a panacea for the negative outcomes associated with sexual minority stressors.

An examination of the independent and intersectional effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care visits among Black sexual minority women in the USA.

Experiences of racism and heterosexism in medical settings are social and systemic barriers to 'on-time' receipt of sexual and reproductive health services among women with both racial and sexual minority identities. Medical mistrust based on experiences related to these dual identities is associated with avoidance and delays in care. However, investigators are just beginning to apply an intersectional lens to quantitatively understanding such barriers. The purpose of this study was to examine the independent and interaction effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care among Black sexual minority women who have sex with women and men. A total of 320 women participated in an online study of factors affecting sexual health in this population. Ordinal logistic regression was used to assess the independent and interaction effects of racial and heterosexist medical mistrust on self-reported time since last sexual/reproductive health visit. Results indicated an interaction between the two types of medical mistrust. Research on Black women who have sex with women and men's experiences of racism and heterosexism in the US healthcare system can lead to the development of the comprehensive training programmes needed to alleviate medical mistrust among women with racial and sexual minority identities.

Long-term care planning and the influencing factors among sexual minority older women: A qualitative study.

AIMS: The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women. DESIGN: Qualitative interview study. METHODS: Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis. RESULTS: The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. CONCLUSION: This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. IMPACT: This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women. PATIENT OR PUBLIC CONTRIBUTION: SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

The Role of Shame in the Relationship between Alcohol Use Severity and Relational Intimacy among Sexual Minority Women.

Background: Sexual Minority Women (SMW) are disproportionately likely to struggle with substance use and shame, two factors that are associated with poorer relationship quality and decreased relational intimacy (Doyle & Molix, 2015). However, there is a dearth of research examining shame and substance use concurrently among SMW. Objectives: The current study elucidated the role of shame-based cognitions (SBCs) and shame-based behaviors (SBBs) in explaining the relationship between alcohol use severity and relational intimacy. We recruited adult cisgender women (N = 105) in a romantic relationship who self-identified as a sexual minority and reported alcohol use during the past three months through Amazon Mechanical Turk. Participants completed an online survey assessing alcohol use, SBCs, SBBs, and relational intimacy. Results: There was a significant positive relationship between alcohol use severity with SBCs (r = .29, p = .003) and with SBBs (r = .62, p <.001). SBBs were shown to be negatively correlated with relational intimacy (r = -.48, p < .001). Parallel mediation analysis demonstrated that SBCs and SBBs accounted for approximately 34.4% of the variance in intimacy. The indirect effects of SBCs were significant (ß = .10, 95% CI [.02, .18] while SBBs (ß = -.14, 95% CI [-.29, .01]) did not show effects. Discussions: Given the disproportionate rates of alcohol use among SMW, this study offers a nuanced picture of the relationships between constructs known to impact alcohol use. The findings underscore the importance of SBCs and point to a potential treatment target among SMW presenting with alcohol use and diminished relational intimacy.

Engaging Black sexual minority women in breast cancer research: Lessons in community partnerships.

BACKGROUND: Black sexual minority women (BSMW) face significant breast cancer health inequities and are underrepresented in health research because of historical and present-day exclusion. However, there exists no peer-reviewed literature on best practices for the inclusion of BSMW in cancer research. "Our Breast Health: The Access Project" was a national primary data collection study in June 2018 through October 2019 that aimed to identify facilitators and barriers to breast cancer care among BSMW, and that successfully recruited the highest number of BSMW for any national breast cancer screening study at the time of its publication. METHODS: The present analysis highlights best practices for reaching BSMW by examining by how effective various recruitment sources were at recruiting BSMW. Recruitment partners were grouped into several categories: (1) cancer focused, (2) Black women or sexual minority women focused, (3) BSMW focused, (4) social media, and (5) other. Then logistic regression was used to estimate the odds that a particular recruitment source category could recruit BSMW compared with other categories. RESULTS: Partnerships with community-based organizations led by and intended for BSMW were the most successful at recruiting BSMW, demonstrating the importance of an intersectional approach to recruitment. Community-based organizations focused on BSMW specifically were 26 times more successful in recruiting BSMW to the study compared with recruiting Black women who were not sexual minorities (odds ratio, 26.43 [95% CI, 7.50-93.10]). CONCLUSIONS: Successful recruitment enables breast cancer research grounded in the perspectives of BSMW, which can generate key findings that have the potential to remedy longstanding health inequities for this population.

Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis.

Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results. OBJECTIVE: Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA. METHODS: All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies. RESULTS: The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (ß = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (ß = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables. CONCLUSIONS: Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.

Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial.

BACKGROUND: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. OBJECTIVE: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m2) to improve health outcomes. METHODS: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. RESULTS: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. CONCLUSIONS: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women.

PTSD Symptoms and Hazardous Drinking Indicators among Trauma-Exposed Sexual Minority Women during Heightened Societal Stress.

Trauma-exposed sexual minority women (SMW) are at elevated risk of posttraumatic stress disorder (PTSD) and hazardous drinking compared to trauma-exposed heterosexual women. To understand whether these problems might be exacerbated during times of elevated societal stress, we collected data from a New York-based sample of trauma-exposed SMW between April 2020 and August 2020, a period of notable, compounding societal stressors, including: (a) living in or near one of the first epicenters of the coronavirus disease 2019 (COVID-19) epidemic in the United States and (b) living through multiple high-profile occurrences of racism-related police violence and subsequent racial unrest. SMW (n = 68) completed online self-report questionnaires related to trauma, PTSD symptoms, and alcohol use, and a subset (n = 29) completed semi-structured qualitative interviews. PsycINFO was searched with terms related to SMW, PTSD, and alcohol use to identify studies with samples of SMW from articles published within the last 10 years to which we could compare our sample; this produced nine studies. Welch's t-tests and Chi-square analyses revealed that SMW within our sample reported significantly higher PTSD symptom severity, probable PTSD, and hazardous drinking indicators (i.e., alcohol use disorder and heavy episodic drinking) between April 2020 and August 2020 compared to similar samples (i.e., trauma-exposed SMW and general samples of SMW) assessed previously. Qualitative reports also indicated that the societal stressors of 2020 contributed to mental and behavioral health concerns. These results underscore the need for integrated PTSD and alcohol use prevention and intervention efforts for trauma-exposed SMW during times of heightened societal stress.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2006132 .

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members.

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Black sexual minority women's Internalized stigma and coping motivated alcohol use: the role of emotional suppression.

Black sexual minority women have an increased risk for excessive alcohol use, which has been attributed to their use of alcohol to cope with oppression. Internalized stigma is suggested to be one of the most insidious byproducts of systemic oppression whereby people internalize ideologies of self-hatred. Still, research has yet to examine the association between internalized stigma and alcohol use among sexual minorities of color. This survey-based study investigated the associations between internalized homonegativity and internalized racism with coping motivated alcohol use among 330 Black sexual minority women. Additionally, we explored the role of emotional suppression within these associations. Internalized homonegativity was significantly positively associated with coping motivated alcohol use. The significant positive association between internalized racism and coping motivated alcohol use was strongest at higher levels of emotional suppression. Given the majority of our sample identified as having a masculine gender expression, we recommend research exploring whether the identity-based experiences of masculine Black sexual minority women impact their substance use behaviors. Implications for culturally sensitive and emotion-centered practice with Black sexual minority women are discussed.

Multivariate Patterns of Substance Use, Minority Stress and Environmental Violence Associated with Sexual Revictimization of Lesbian and Bisexual Emerging Adult Women.

This study documented between-group differences in factors associated with sexual revictimization histories in a sample of young sexual minority women. Diverse samples of lesbian (N = 204, ageM = 23.55 years) and bisexual (N = 249, ageM = 23.35 years) women from the United States were recruited using the CloudResearch platform to assess factors associated with recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on self-reports of sexual victimization (a) during childhood and (b) during adulthood in intimate relationships. Multivariate Analysis of Variance (MANOVA) was used to model between-group differences in three variable domains: Past-year substance use involvement, minority stress, and violence in relationship and community settings. Lesbian women reporting sexual revictimization in adulthood reported significantly higher scores for measures of past-year substance use involvement and negative consequences, daily discrimination experiences, relational victimization, and criminal victimization, compared to their counterparts with no history of sexual victimization. Among bisexual women, sexual revictimization was associated with a similar pattern of between-group differences. The sexual revictimization experiences of sexual minority women appear to occur in the context of multivariate patterns of harmful substance use, minority stress, and violence in both relationship and community settings. Our findings have implications for how intervention services are provided to emerging adult sexual minority women who experience multiple episodes of sexual abuse during their lifespans. Recommendations include specialized training for counseling or intervention service providers, integrated trauma-informed services that address both substance use and sexual assault issues, and affirmative services for sexual minority women.

International perspectives on lesbian psychology.

Researchers from the Philippines, Mexico, Italy, Germany, Chile, Canada, Brazil, China, and the US shed new light on important questions in lesbian psychology while subverting the hegemonic status of Western scholarship. Articles part of this special issue move away from treating LGBTQ + identity as a monolith and center lesbian identity. An eclectic set of contributions explore central questions in the field of psychology, including differences between gay men's and lesbian women's mental health as well as similarities and differences between bisexual and lesbian women's sense of identity. This special issue pushes the field to consider how cultural values such as collectivism and individualism, religious affiliation, and the intersections of misogyny and homophobia configure the risk of mental health problems, intimate partner violence, and body dissatisfaction among lesbian women.

Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women.

BACKGROUND: Sexual minority women (SMW) report higher rates of heavy episodic drinking (HED) and adverse alcohol-related outcomes, including poor mental health, than heterosexual women. These disparities indicate a greater need for behavioral and mental health treatment for SMW. This study examined associations among alcohol outcomes, behavioral and mental health help-seeking, and treatment satisfaction among SMW by age, sexual identity, race/ethnicity, and income. METHODS: Participants included a community sample of 695 SMW (Mage  = 40.0, SD = 14.1; 74.1% lesbian, 25.9% bisexual; 37.6% White, 35.8% Black, 23.2% Latinx; 26.3% annual income $14,999 or less). We used bivariate analyses to characterize the sample's demographic characteristics and multivariable logistic regression analyses to examine associations among variables. RESULTS: SMW subgroups based on age, race/ethnicity, and annual income differed in alcohol outcomes (i.e., HED, DSM-IV alcohol dependence, alcohol-related problem consequences, alcohol problem recognition, and motivation to reduce drinking); help-seeking; and treatment satisfaction. SMW who engaged in help-seeking for alcohol-related concerns were more likely than those who did not to meet criteria for DSM-IV alcohol dependence (adjusted odds ratio [aOR] = 7.13; 95% CI = 2.77; 18.36), endorse alcohol-related problem consequences (aOR = 11.44; 95% CI = 3.88; 33.71), recognize problematic drinking (aOR = 14.56; 95% CI = 3.37; 62.97), and report motivation to reduce drinking (aOR = 5.26; 95% CI = 1.74; 15.88). SMW's alcohol outcomes did not differ based on their satisfaction with treatment or with providers. CONCLUSIONS: This study's findings confirm SMW's elevated risk for HED and other alcohol-related outcomes and underscore the importance of identity-affirmative and accessible behavioral and mental health treatment for young, Black, and low-income SMW. Clinicians and intervention scientists should develop or enhance existing brief behavioral and mental health treatments for SMW engaging in HED who may not recognize that their drinking is problematic or who are not motivated to reduce drinking.

Heterosexual Marital Intention: The Influences of Confucianism and Stigma Among Chinese Sexual Minority Women and Men.

In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite sex partner. This study explored how Confucianism and stigma were associated with the intention to pursue a heterosexual marriage among Chinese sexual minority individuals as well as the moderating mechanisms of gender and age. Cross-sectional data were collected from 747 participants via online social networks from March to June 2020. Items assessed Confucianism values (communalism, filial piety, traditional gender roles); stigma (rejection sensitivity, social discrimination); and heterosexual marital intention (HMI). A total of 1.7% (n = 12) participants had ever been married, 11.6% (n = 87) planned to marry a different-sex partner, 60.4% (n = 451) had no intention to pursue a heterosexual marriage, and 26.4% (n = 197) had no specific marital plan. Bisexual participants scored significantly higher than homosexual individuals in HMI. Sexual minority adults with high levels of Confucianism and stigma were more likely to intend to marry. Importantly, both individual stigma (rejection sensitivity) and interpersonal stigma (social discrimination) partially mediated the relationship between Confucianism and HMI. Confucianism had a stronger impact on HMI for men than women, and age moderated the influence of Confucianism (including communalism and filial piety) on HMI, with a stronger impact for younger than older generations. This study contributes to a better understanding of how Confucianism and stigma may be connected to the intention to pursue a heterosexual marriage, suggesting culture-modified theories of stigma and sexual minority stress are needed to explain the experiences of sexual minority people in contemporary China.

Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women.

Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = - 6.71, SE = 2.49) and education (b = - 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = - 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = - 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = - 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = - 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.

A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: Randomized Controlled Trial and Feasibility Study.

BACKGROUND: Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption. OBJECTIVE: We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media-inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)-identified sexual minority women. METHODS: Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition's ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity-specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF. RESULTS: A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole. CONCLUSIONS: The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity-specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes. TRIAL REGISTRATION: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/24647.